NURS-FPX4030 Assessment 3 Example

NURS-FPX4030 Assessment 3 Example

PICO(T) framework and Type 1- Diabetes 

Population, intervention, comparison, outcome, and time comprise the PICOT framework (McEwen & Wills, 2017). The aspect of time is not always applicable and only does when need be. The use of the PICOT framework helps in improving the specificity and conceptual clarity of clinical problems. In studies, PICOT is used to formulate questions in evidence-based practice. These questions should entail every element of the PICOT framework. It helps design research and identifies the key concepts that need to be an article or a study that ensures high quality of findings.

NURS-FPX4030 Assessment 3 Example

Use of the PICO(T) Approach when Caring for Patients with Type 1 Diabetes

The question addresses how self-monitoring of blood glucose is not as effective as the use of glucose monitoring technologies to provide better HbA1c for type one diabetic patients.  The question to be analyzed in this paper is: In patients with type 1 diabetes and uncontrolled blood glucose levels, how does continuous use of glucose monitoring technologies compared to self-monitoring of blood glucose provide better HbA1c control.

The study population is patients with type-1 diabetes with uncontrolled blood sugar levels. The intervention suggested is monitoring technologies over the convectional finger stick method (DiMeglio et al., 2018). The comparison is to find the most effective intervention by monitoring blood glucose levels using monitoring technologies and the convectional finger stick method. The outcome is to determine if continuous monitoring technology lowers the HbA1c. In this case study, there are no time frames decided on.

Identification of Source Evidence

Dexcom CGM

The PICOT compares continuous glucose monitoring methods and self-monitoring of blood glucose. Dexcom is a quintessence of a technology used in the continuous monitoring of blood glucose, a device used by diabetic patients to provide a real-time look at blood glucose levels for 24 hours. The Dexcom G6 is an automated applicator that uses a comfortable sensor inserted just beneath the skin and a Dexcom G6 mobile app to provide a simple and one-touch method for glucose measurement. The mobile app displays glucose information, triggering alerts and alarms that notify the patient of the glucose levels.

There are customizable alarms and alerts for low and high blood glucose levels for ease of interpretation. The data can then be translated into graphs, patterns, and trends that are simple to interpret and useful, especially when determining progress over a month or over a specific time period. Continuous glucose monitoring technologies outperform self-monitoring of blood glucose, which does not provide a continuous reading throughout the 24 hour period and does not provide trends, patterns, or statistics.

The use of the Dexcom G6 is justified by the technology’s ability to empower patients to make more informed decisions about their conditions’ management. This is accomplished by sending real-time glucose monitoring to the patients’ smart phones. Compared to self-monitoring of blood glucose, studies show that the technology has a beneficial effect on lowering HbA1C and reducing the frequency of hypoglycemia.

Closed-loop Insulin Delivery

People with type 1 diabetes benefit from an emerging technology that is used for both therapeutic and monitoring purposes. The closed-loop Insulin delivery is a medical device that works in conjunction with a glucose monitor and an insulin pump. Wireless communication allows for automated data transfer between components without the need for human intervention. This device allows for continuous blood glucose monitoring. This is the foundation of the technology’s use, and when compared to self-glucose monitoring, it is superior in terms of lowering HBA1C and lowering the frequency of hypoglycemia. NURS-FPX4030 Assessment 3 Example

Findings from Articles

According to Roz et al. (2020), glycemic controls improved with the use of Dexcom G6 RT-CGM continuous glucose monitor. Also, it helped reduce the fear of hyperglycemia and improve the quality of life in patients. The use of continuous glucose monitors (CGM) cuts health-related costs as opposed to self-monitoring blood glucose (SMBG). Continuous technology monitoring was associated with reduced levels of HbA1c as compared to self-monitoring. Type 1- diabetes patients who use continuous glucose monitor spend little to nothing on costs associated with long-term diabetes-related complications, as the intervention has a cost-effective disease management option.

A randomized parrel-group control involving twenty-two type one diabetes mellitus was conducted to find which method was most effective. According to Helmi & Hussain, (2021 NURS-FPX4030 Assessment 3 Example), the result collected from using both interventions were equivalent making both interventions equally important in the study. However, detecting hypoglycemia proved to be more effective with a continuous glucose monitoring system in children.

The article focused on whether there are clinical benefits associated with the adoption of a real-time continuous glucose monitoring system in type one diabetes (Styles et al., 2021). The study found that using this significantly lowered hemoglobin A1C compared to interventions associated with the non-use of technology devices (Styles et al., 2021). Also, CGMS reduced the chances of patients with type-1 diabetes getting hospitalized for hypoglycemia. Patients are better able to have glycemic control instead of using other interventions.

Relevance of Findings from Articles

All the three articles discussed above were chosen because they support the research into the study’s PICO(T) question. The three articles are reliable because they use credible sources, thus making the result valid and applicable to my PICOT question. Its main aim is to find if the use of the continuous glucose monitoring system lowers the HbA1c instead of using self-monitoring blood glucose.

According to Roz et al., (2020), the first study was chosen because it provides a comparative study based on the two interventions. Additionally, it was ideal as it supports the hypothesis made by the PICOT question. It is significant as it answers the PICOT question. The PICOT questions seek to find the two interventions: CGMS or SMBG, which lowers the HbA1c, which this article addresses.

Article two focuses on type-1 diabetes in children. This allows me to get another perspective based on another demographic in the same population. The article is scholarly, and peer-reviewed (Helmi & Hussain, 2021). Therefore, making the study results accurate, reliable, and high quality. The report compares CGMS and SMBG, which my PICOT question focuses on; hence I can apply the analysis in the article to answer my PICOT question. Similar to the third article, CGMS proves to be effective in lowering HbA1c improving glycemic control and safe time reducing risks of being hospitalized because of issues of hypoglycemia (Styles et al., 2021).

Conclusion

The article analyzed in this study proposes that the participants of the study showed improved glycemic controls when they used CGMS for all ages, from older adults to children, as opposed to SMBG. Although CGMS is an expensive intervention upon first investment, it has a lot of advantages for patients. All articles recommend using this intervention, especially for patients with type 1 diabetes.

NURS-FPX4030 Assessment 3 Example References

DiMeglio, L. A., Evans-Molina, C., & Oram, R. A. (2018). Type 1 diabetes. Lancet, 391(10138), 2449–2462. https://doi.org/10.1016/s0140-6736(18)31320-5

Muhd Helmi, M. A., Bachok, N., & Hussain, S. (2021). Continuous glucose monitoring system versus self-monitoring blood glucose in type 1 Diabetes Mellitus children: A randomised controlled trial (RoSEC). Malaysian Journal of Paediatrics and Child Health, 27(2), 51–68. https://doi.org/10.51407/mjpch.v27i2.152

McEwen, M., & Wills, E. M. (2017). Theoretical basis for nursing (5th ed.). Wolters Kluwer Health.

Roze, S., Isitt, J., Smith-Palmer, J., Javanbakht, M., & Lynch, P. (2020). Long-term cost-effectiveness of Dexcom G6 real-time continuous glucose monitoring versus self-monitoring of blood glucose in patients with type 1 diabetes in the UK. Diabetes Care, 43(10), 2411-2417

Styles, S., Wheeler, B., Boucsein, A., Crocket, H., de Lange, M., Signal, D., Wiltshire, E., Cunningham, V., Lala, A., Cutfield, W., de Bock, M., Serlachius, A., & Jefferies, C. (2021). A comparison of Freestyle Libre 2 to self-monitoring of blood glucose in children with type 1 diabetes and sub-optimal glycaemic control: A 12-week randomised controlled trial protocol. Journal of Diabetes & Metabolic Disorders, 1-9.

Seers, K., Rycroft-Malone, J., Cox, K., Crichton, N., Edwards, R. T., Eldh, A. C., … & Wallin, L. (2018). Facilitating implementation of research evidence (FIRE): an international cluster randomised controlled trial to evaluate two models of facilitation informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Implementation Science, 13(1), 1-11.

Assessment 3 Instructions: PICO(T) Questions and an Evidence-Based Approach

  • Create a 3-5 page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question.

Introduction – NURS-FPX4030 Assessment 3 Example

PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.

It stands for:

    • P – Patient/population/problem.
    • I – Intervention.
    • C – Comparison (of potential interventions, typically).
    • O – Outcome(s).
    • T – Time frame (if time frame is relevant).

The end goal of applying PICO(T) is to develop a question that can help guide the search for evidence (Boswell & Cannon, 2015). From this perspective, a PICO(T) question can be a valuable starting point for nurses who are starting to apply an evidence-based model or EBPs. By taking the time to precisely define the areas in which the nurse will be looking for evidence, searches become more efficient and effective.

Essentially, by precisely defining the types of evidence within specific areas, the nurse will be more likely to discover relevant and useful evidence during their search.  When applying the PICO(T) approach, the nurse can isolate the interventions of interest and compare to other existing interventions for the evidenced impact on the outcome of the concern.

You are encouraged to complete the Vila Health PICO(T) Process activity before you develop the plan proposal. This activity offers an opportunity to practice working through creating a PICO(T) question within the context of an issue at a Vila Health facility. These skills will be necessary to complete Assessment 3 successfully. This is for your own practice and self-assessment and demonstrates your engagement in the course.

Reference

Boswell, C., & Cannon, S. (2015). Introduction to nursing research. Jones & Bartlett Learning.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for locating and identifying credible and scholarly resources to incorporate the best available evidence for the purposes of enhancing clinical reasoning and judgement skills. When reliable and relevant evidence-based findings are utilized, patients, health care systems, and nursing practice outcomes are positively impacted.

PICO(T) is a framework that can help you structure your definition of the issue, potential approach that you are going to use, and your predictions related to the issue. Word choice is important in the PICO(T) process because different word choices for similar concepts will lead you toward different existing evidence and research studies that would help inform the development of your initial question. When writing a PICO(T)-formatted research question, you want to focus on the impact of the intervention and the comparison on the outcome you desire.

Scenario

For this assessment, please use a health care issue of interest from your current or past nursing practice.

If you do not have an issue of interest from your personal nursing practice, then review the optional Case Studies presented in the resources and select one of those as the basis for your assessment.

Instructions – NURS-FPX4030 Assessment 3 Example

For this assessment, select a health care issue of interest and apply the PICO(T) process to develop the research question and research it.

Your initial goal is to define the population, intervention, comparison, and outcome. In some cases, a time frame is relevant and you should include that as well, when writing a question you can research related to your issue of interest. After you define your question, research it, and organize your initial findings, select the two sources of evidence that seem the most relevant to your question and analyze them in more depth. Specifically, interpret each source’s specific findings and best practices related to your issues, as well explain how the evidence would help you plan and make decisions related to your question. NURS-FPX4030 Assessment 3 Example

If you need some structure to organize your initial thoughts and research, the PICOT Question and Research Template document (accessible from the “Create PICO(T) Questions” page in the Capella library’s Evidence Based Practice guide) might be helpful.

In your submission, make sure you address the following grading criteria:

    • Define a practice issue to be explored via a PICO(T) approach. Create a PICO(T)-formatted research question
    • Identify sources of evidence that could be potentially effective in answering a PICO(T) question (databases, journals, websites, etc.).
    • Explain the findings from articles or other sources of evidence as it relates to the identified health care issue.
    • Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
    • Communicate using writing that is clear, logical, and professional with correct grammar and spelling using the current APA style. NURS-FPX4030 Assessment 3 Example

Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like:

Additional Requirements – NURS-FPX4030 Assessment 3 Example

Your assessment should meet the following requirements:

    • Length of submission: Create a 3–5-page submission focused on defining a research question and interpreting evidence relevant to answering it.
    • Number of references: Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.
    • APA formatting: Format references and citations according to the current APA style.

Portfolio Prompt: Remember to save the final assessment to your ePortfolio so that you may refer to it as you complete the final capstone course.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

    • Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.
      • Explain the findings from articles or other sources of evidence that are relevant to the health care issue.
    • Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.
      • Identify sources of evidence that could be potentially effective in answering a PICO(T) question.
      • Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.
    • Competency 3: Apply an evidence-based practice model to address a practice issue.
      • Define a practice issue to be explored via a PICO(T) approach and develop a PICO(T)-formatted research question.
    • Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence. NURS-FPX4030 Assessment 3 Example
      • Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling.
      • Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.

PICO(T) Questions and an Evidence-Based Approach Scoring Guide

CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Define a practice issue to be explored via a PICO(T) approach and develop a PICO(T)-formatted research question.  Does not define a practice issue to be explored via a PICO(T) approach. Identifies a practice issue, but does not frame it within the context of a PICO(T) question or approach. Defines a practice issue to be explored via a PICO(T) approach. Develops a PICO(T)-formatted research question. Defines a practice issue to be explored via a PICO(T) approach. Develops a PICO(T)-formatted research question. Notes how the exploration of the practice issue will benefit from a PICO(T) approach.
Identify sources of evidence that could be potentially effective in answering a PICO(T) question. Does not identify sources of evidence that could be potentially effective in answering a PICO(T) question. Attempts to identify sources of evidence, but does not connect them to the PICO(T) question, or the connection is unclear. Identifies sources of evidence that could potentially be effective in answering a PICO(T) question. Identifies sources of evidence that could be potentially effective in answering a PICO(T) question. Presents criteria or rational used to determine potential to answer the PICO(T) question.
Explain the findings from articles or other sources of evidence that are relevant to the health care issue. Does not explain the findings from articles or other sources of evidence that are relevant to the health care issue Lists the findings from articles or other sources of evidence, but does not offer a full explanation. Explains the findings from articles or other sources of evidence that are relevant to the health care issue. Explains the findings from articles or other sources of evidence that are relevant to the health care issue. Notes which sources are the most credible.
Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question.  Does not explain the relevance of the findings from chosen sources of evidence. Identifies the relevance of the findings from chosen sources of evidence, but does not offer a full explanation of how it relates to the PICO(T) question. Explains the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question. Explains the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question. Notes which findings are the most relevant or likely to lead to positive outcomes.
Organize content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling. Does not organize content so ideas flow logically with smooth transitions. Contains errors in grammar/punctuation, word choice, and spelling. Attempts to organize content with some logical flow and smooth transitions. Contains several errors in grammar/punctuation, word choice, and spelling. Organizes content so ideas flow logically with smooth transitions; contains few errors in grammar/punctuation, word choice, and spelling. Organizes content with a clear purpose. Content flows logically with smooth transitions using coherent paragraphs, correct grammar/punctuation, word choice, and free of spelling errors.
Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format. Does not apply APA formatting to headings, intext citations, and references. Does not use quotes or paraphrase correctly. Applies APA formatting to in-text citations, headings and references incorrectly and/or inconsistently, detracting noticeably from the content. Inconsistently uses headings, quotes and/or paraphrasing. Applies APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format. Exhibits strict and flawless adherence to APA formatting of headings, intext citations, and references. Quotes and paraphrases correctly.

See NURS-FPX4030 Assessment 4 Remote Collaboration and Evidence-Based Care Here